India's Birth-Rate Burden: One Northern Village Tells the Story

By STEVEN R. WEISMAN, Special to the New York Times

Published: January 11, 1988

GURHA, India—
Looking drawn and tired, Ram Kumari all but admitted that she was unlikely to become pregnant again. In the last 20 years, she had given birth to six children, only four of whom survived, and now her husband was weak and ailing, unable to farm or harvest this year's rice.

Mrs. Kumari listened intently while the elected headman of this northern Indian village tried to persuade her to have a sterilization operation the next day. The incentive offered was $11 -equivalent to a few weeks' pay - and a vague promise of some extra farmland. But she felt sterilization might leave her too weak to work and support her husband and children.

''It frightens me,'' she said, nervously adjusting her faded cotton sari. ''There are so many other women available for this operation. Why aren't they going?'' In the end, she decided no.

With a population of nearly 8,000, compared with 5,000 in 1980, Gurha is a microcosm of the problems that have long stood in the way of population control in India. Mrs. Kumari's case also illustrates the difficulties and paradoxes surrounding the issue. One Short of Quota

For example, the pressures she felt seemed to have come mainly from the fact that Gurha was one operation short of meeting its annual female sterilization quota imposed by the authorities in New Delhi and Lucknow, the capital of Uttar Pradesh state.

The village headman trying to persuade Mrs. Kumari knew that if Gurha failed to meet its target, the chief family health officer, who happens to be his wife, could lose a pay increase due next spring. Afterward, he was philosophical about Mrs. Kumari's refusal, saying others could be found to meet the target.

In New Delhi and Lucknow, some officials deplore what they call ''target fever.'' There have been widespread reports throughout India of fraudulent reporting of sterilizations and of sterilizations being performed on women who can no longer bear children, just so quotas can be met.

Two main problems plague population-control efforts in Gurha, as elsewhere in India. First is the old attitude favoring large families with at least two sons, and second is the inadequacy of Government health services for mothers and children, which might give families the confidence to practice birth control. Richer Means Fewer

In interviews, only those families with several acres of farmland generating enough money to send children to school said they had an incentive to keep their families small. Several said it made little economic sense to split up their land into tiny plots owned by a large number of children. But even their attitudes are not always sufficient to limit the number of children to two, the Government's target.

''In this village, we are failing in the battle to spread family planning,'' said Bilqish Jahan, the family health officer. ''The amount of medical care available here is also not sufficient. Maybe if we offered more services, people would have an incentive to change.''

Mrs. Jahan and another health officer, K. L. Tiwari, said between 5 percent and 15 percent of Gurha's 700 families practiced family planning, far less than the officially reported nationwide rate of 35 percent.

Mrs. Jahan said the most favored method was the intrauterine device, followed by the condom, sterilization and the pill, but the only method that people seemed willing to discuss during a recent visit was sterilization. Two Sons and a Daughter

Many people here said they believed in family planning but also needed at least two sons and one daughter to a family. Often this meant having four or five children.

As elsewhere in India, daughters in Gurha are expected to move in with their in-laws, and sons may be the sole source of income during old age.

Without sons, many Hindu families believe they have no one to preside over the funerals of parents. As for daughters, families consider it a blessing to provide a ''kanyadaan,'' or gift of a bride to another family.

''If God gives me two sons, I must also have a daughter,'' said Uma Devi, a 40-year-old mother of three.

Others, especially those with no land to cultivate, look on children as a financial asset. ''I have to depend on my kids to bring in money,'' said Rama Raja, who was pregnant with her fourth child. 'More Hands to Work'

Her friend, Ram Dei, who has three children, agreed. ''The more children you have, the more hands there are to work,'' she said.

In Gurha, families with more property harbor greater aspirations for their sons and even daughters and therefore look on additional children as more mouths to feed.

''People are getting fed up,'' said Shree Pal, a landowning farmer with a stubbly gray beard and a torn T-shirt. ''The cost of living today is just too high. It's impossible to keep a minimum standard of living unless you have a small family.''

He said he decided to have a vasectomy after his fourth child, but the doctor failed to show up each time he went. By the time he had the operation, he had six children.

Even Mrs. Jahan, the health officer, said she had five children before her husband agreed to a vasectomy. The first was a boy. The next three were girls before they had another son.

''I could never persuade someone without sons to adopt birth control,'' Mrs. Jahan said. Aim to Improve Survival The Government has emphasized improving health services in Gurha and elsewhere because it believes people will have fewer children if they can insure their survival. But achieving this is only a distant hope in Gurha.

Mrs. Jahan, whose title is auxiliary nurse midwife, operates out of a dilapidated brick shed attached to her house that serves as the village's health center. She said she ran out of most medicines for four or five months each year, and as a result villagers had no reason to expect that the Government has their health interests at heart.

''When I tell most people to stop producing children, they say it is none of my business,'' Mrs. Jahan said. ''They say it's their responsibility and they'll manage, and they ask me: 'Why are you preaching to us? We aren't asking anything from you.' ''

Regulations for Uttar Pradesh, in which Gurha lies, call for each auxiliary nurse midwife to have no more than 5,000 people under her jurisdiction. Mrs. Jahan said she was responsible for 12,000 in three villages, although she is supposed to get help soon. Operations at Six-Bed Center

Sterilizations are performed at a six-bed installation in the town of Sheoghar, several miles from Gurha, that serves 70,000 people in the district. The men receive vasectomies, and the women undergo an operation known as laparoscopy, in which rings are placed around the Fallopian tubes.

The village health officials say these surgical procedures lead to enough adverse effects to reinforce people's fear that the operation will make them impotent or weak.

Sometimes a vasectomy has been performed improperly, and the wife still gets pregnant, leading the husband to accuse her of infidelity.

The main health problems in Gurha are fever, dysentery, diarrhea, eye diseases and malaria, carried by mosquitoes that breed in nearby swamps. Senior Indian health officials hope that by 1990, they will reach a goal of immunizing all mothers and children for tetanus, a principal killer, and for polio and other diseases. But Dr. Rakesh Kumar Singh, director of the Sheoghar health center, said only 40 percent of the goal had been met. Politics Has an Effect

Because Mrs. Jahan is married to the Mr. Ahmed, the village headman, politics appears to have become a factor in the delivery of immunizations and other health services.

Fifteen months ago, a man in one lower-caste community got into a fight with Mr. Ahmed's father over the building of a wall next to their fields, The two ended up beating each other with sticks. The people complained that as a result, Mrs. Jahan never visited their community to give immunization shots.

''She only shows up in places where it will do her some good,'' said a woman from the community.

Another aspect of the Government's family planning drive has achieved uncertain results and stirred resentment in Gurha.

Local development administrators are supposed to give preference to families practicing birth control in granting loans to purchase water buffalo or construct bio-gas tanks.

The men of the hamlet of Chandapur, one of several outlying communities that are part of Gurha village, said that as a result of such pressure, 75 percent of the families in their communities had sterilization operations.

''They promised that they would fix the road to our hamlet,'' said Raghunath Prasad, who had a vasectomy after fathering three children. ''But nothing has been done. Their promises were empty.''

In Lucknow, state officials said they were pleased with the progress achieved from a separate program training local midwives, who come from lower-caste families where this has been the traditional occupation.

Mrs. Jahan is supposed to attend to births in the village, helping with immunizations and working to get expecting mothers to a hospital if complications arise. But villagers say they rely more on the traditional midwives. Cow Dung Mixture Used

For the last 17 years, Ram Kali, a midwife in her 40's, has spread cow dung mixed with water on the mud floor of the house she visits in the belief that it serves as a disinfectant. Health officials said they had not tried to discourage the practice, ingrained in a country where worship of the cow is central to religious life.

But Mrs. Kali said she had also learned to wash the mother with boiled water and to sterilize the knife used to cut the baby's umbilical cord. It was not long ago that babies died of tetanus from dirty knives.

Mrs. Kali tries to remind mothers of the Government's drive for smaller families. ''In some cases they accept what I say, and sometimes not,'' she said.

Another midwife, Ram Rati, added: ''Sometimes they get so angry, and they ask me, 'Why don't you practice what you preach?' They say, 'I'll practice family planning when I feel like it, and not before.' '' THE SERIES SO FAR

The first article of this series on Gurha, India, appeared on Oct. 26. It described the hardships of village life, including broken family ties, caste divisions, increasing crime and political corruption, and the worst drought in memory.

Photo of Indian women with large family (NYT/Steven R. Weisman); map of India highlighting village of Gurha (NYT)